Subclavian and axillary involvement in temporal arteritis and polymyalgia rheumatica.
OBJECTIVE
We describe 10 female patients with temporal arteritis (TA) and/or polymyalgia rheumatica (PMR) who presented with upper-extremity ischemia.


RESULTS
Arm claudication or Raynaud's phenomenon was the initial manifestation of the disease in four cases, appeared with classical symptoms in one case, or occurred during decreasing corticosteroid therapy in five cases. Temporal artery biopsy was performed in nine patients and showed typical giant-cell granulomatous arteritis in seven cases. Angiograms in all cases showed multiple bilateral smooth stenoses, or obliterations of postvertebral subclavian and/or axillary arteries, or both. Symptoms always improved with corticosteroid treatment and none of the patients required reconstructive surgery, although angiography performed after stabilization did not show revascularization of occluded vessels.


CONCLUSIONS
We conclude that large-artery involvement in TA and PMR affects most commonly the subclavian and axillary arteries, with a female predominance comparable to that in Takayasu's arteritis. Both these disorders should be considered in elderly women with occlusive disease of the upper extremities. Although response to steroid therapy was sufficient in our series to avoid surgery, we believe it is preferable to recognize large-artery involvement as early as possible and recommend performance of ultrasonic Doppler examination when any sign of oncoming ischemia or stenosis is observed.
Ninet
J P
JP
Département de Médecine Interne, Hôpital Edouard Herriot, Lyon, France.
Bachet
P
P
Dumontet
C M
CM
Du Colombier
P B
PB
Stewart
M D
MD
Pasquier
J H
JH
D000368:Aged; D001132:Arm / Q000098:blood supply; D001366:Axillary Artery / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D013700:Giant Cell Arteritis / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology*; D006801:Humans; D007511:Ischemia / Q000209:etiology; D008875:Middle Aged; D011111:Polymyalgia Rheumatica / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology*; D011241:Prednisone / Q000627:therapeutic use; D011859:Radiography; D013348:Subclavian Artery / Q000000981:diagnostic imaging / Q000473:pathology*
D011241:Prednisone